The absolute indications for emergency treatment of angiomas are: rapid tumor growth, extensiveness of the lesion, localization of the vascular formation in the head and neck, ulceration or bleeding, impaired functioning of the affected organ. Expectant tactics justified with signs of spontaneous regression of a vascular tumor.
Surgical treatment is indicated for deep angioma. Surgical treatment of angiomas can include ligation of the adductor vessels, suturing of a vascular tumor, or its complete excision within healthy tissue.
Radiation therapy is used to treat angiomas of complex anatomical localizations (for example, angiomas of the orbit or retrobulbar space) or simple large area hemangiomas. With extensive angioma of the integuments, sometimes hormonal treatment with prednisone is effective.
Electrocoagulation, laser removal, cryodestruction can be used for point angiomas. For small but deep-seated angiomas, sclerotherapy is used – local injections of 70% ethanol, causing aseptic inflammation and scarring of a vascular tumor. Angiomas of the internal organs after prior angiography may be embolized.
The term “angioma” in vascular surgery unites various types of anomalies of the blood vessels (hemangiomas) or lymphatic (lymphangiomas) vessels. According to a number of researchers, angioma is an intermediate link between a tumor and a malformation.
Angiomas can be localized in various tissues and organs, are single and multiple (angiomatosis). The morphological basis of angiomas consists of dilated blood or lymphatic vessels. The size and shape of angiomas vary widely; hemangiomas have a red-blue color, colorless lymphangiomas.
More often angiomas occur in childhood, making up to 70-80% of all congenital tumors in children. Angiomas are prone to progression, sometimes extremely fast. From angiomas should be distinguished telangiectasia – the expansion of blood vessels with the presence of arterio-venous aneurysms.
Angiomas are located mainly on the upper half of the body, including the head and neck (up to 80% of cases). Less common are angiomas of the pharynx, lungs, eyelids and orbits, liver, bones, external genital organs, etc.
Causes of Angio
In most cases, angiomas are congenital. Persistent fetal anastomoses between arteries and veins are believed to be sources of angio development.
An increase in angioma occurs due to the proliferation of the vessels of the tumor itself, which germinate and destroy the surrounding tissues, like the growth of malignant tumors. The true causes of congenital angiomas are not known.
Sometimes angiomas occur after traumatic injuries or accompany the course of other diseases (for example, cirrhosis of the liver or malignant tumors of the internal organs).
First of all, there are angiomas of the blood vessels (hemangiomas) and angiomas of the lymphatic vessels (lymphangiomas).
From the histological point of view, distinguish between monomorphic and polymorphic angiomas. Monomorphic angiomas – true vascular formations emanating from a particular element of a blood vessel (hemangioendothelioma, hemangio-pericitoma, leiomyoma).
A sign of polymorphic angioma is a combination of various elements of the vascular wall, it is possible to transfer one type of tumor to another.
Types of hemangiomas
According to the type of structure, simple, cavernous, branched, combined and mixed angiomas are distinguished.
A simple (capillary, hypertrophic) hemangioma is a growth of newly formed capillaries, small arterial and venous vessels. Capillary hemangiomas are localized on the skin or mucous membranes as a spot of bright red (arterial angiomas) or bluish-purple (venous angiomas) color. The sizes of capillary hemangiomas are different – from limited to giant. When pressing on a vascular tumor, its color fades. Capillary hemangioma is extremely rarely transformed into malignant hemangioendothelioma.
Cavernous (cavernous) hemangiomas are formed by wide spongy cavities filled with blood. Externally, this angioma is a knot of purple-bluish color, with a lumpy surface and a soft-elastic consistency. Palpation or radiological in the thickness of the angioma can be determined angioliths or phleboliths – dense, globular forms of disobstructed blood clots. Cavernous hemangiomas usually have a subcutaneous location. For them, a typical symptom of temperature asymmetry – to the touch of a vascular tumor hotter than the surrounding tissue. With pressure on the tumor, due to the outflow of blood, the hemangioma subsides and fades, and during straining it tenses and increases (the so-called erectile symptom caused by blood flow).
The branchy (rascalous) hemangioma is represented by a plexus of dilated, tortuous vascular trunks. A characteristic feature of this type of angioma is the pulsation, tremor and noise detected above it, like an aneurysm. It is rare, mainly localized on the limbs, sometimes on the face. The slightest trauma to the angioma can lead to threatening bleeding.
Combined hemangiomas combine superficial and subcutaneous location (simple and cavernous angioma). Clinical manifestations depend on the predominance of one or another component of the angioma. Hemangiomas of mixed structure originate from vessels and other tissues (hemlimfangiomas, angiofibromas, angioneuromas, etc.).
The form of the following types of angiomas: stellate, flat, nodular, serpiginous. Separately in the series of vascular tumors are senile angiomas, representing multiple small rounded pink-red formations. Senile angiomas appear after 40 years.
Types of lymphangiomas
Simple, cavernous and cystic vascular formations are distinguished from lymphangiomas. Simple lymphangiomas include enlarged tissue gaps lined with endothelium and filled with lymph. This type of angiomas develops predominantly in the muscles of the tongue and lips and externally represents a soft, colorless tumor.
Cavernous lymphangiomas are multi-chamber cavities formed by lymphatic vessels, with thick walls of muscle and fibrous tissue. Cystic lymphangiomas grow as chylous cysts and can reach significant sizes.
They are found in the neck, groin, mesentery of the intestines, retroperitoneal tissue. The accession of a secondary infection can cause fistula formation and a prolonged, debilitating patient, lymphorrhea.
Clinical manifestations of angiomas depend on the type of vascular tumor, its localization, size and characteristics of the course. Hemangiomas are usually detected shortly after the birth of a child or in the first months of his life. In newborn girls, angiomas are found 3-5 times more often than in boys. In infants, a rapid growth of angiomas can be observed: for example, in 3-4 months the hemangioma can increase to a few centimeters in diameter, capturing a significant surface.
Vascular tumors can be located on any part of the body; taking into account the localization, angiomas of the integumentary tissues (skin, subcutaneous tissue, mucous membranes of the oral cavity and genitals), the musculoskeletal system (muscles and bones), internal organs (liver, lungs, etc.) are distinguished. If the presence of hemangiomas of the epithelial tissues is accompanied by a cosmetic defect, then the hemangiomas of the internal organs can lead to various kinds of disturbances of such important functions as breathing, nutrition, vision, urination, defecation.
Bone hemangiomas can be located in the spine, pelvic bones, skull, long tubular bones of the limbs. Multiple cavernous angiomas are more common in bone tissue, and their growth can be accompanied by pain, skeletal deformity, pathological fractures, radicular syndrome, etc. Brain angiomas that can lead to epilepsy or subarachnoid hemorrhage are particularly dangerous.
In the process of growth, ulceration and inflammation of angiomas can occur, followed by the development of thrombosis and phlebitis. The most terrible complication is bleeding; for extensive and deep angiomas, emergency surgery may be necessary to stop the bleeding. In some cases, self-healing of angiomas, associated with spontaneous thrombosis and desolation of vessels that feed the tumor, occurs. At the same time, the angioma gradually fades or disappears completely.
Angiomas from lymphatic vessels are more often found in children of the first year of life. The place of their primary localization is the skin and subcutaneous tissue.
Lymphangiomas are localized in places of accumulation of regional lymph nodes: on the neck, tongue, lips, cheeks, in the axillary and inguinal region, mediastinum, retroperitoneal space, in the area of the mesentery root. They are defined as a painful swelling, sometimes reaching a considerable size. In most cases, the growth of lymphangiomas is slow, of the complications usually found suppuration.
Diagnosis of angiomas
Diagnosis of superficial angiomas in typical cases is not difficult and is based on the data of inspection and palpation of the vascular formation. Characteristic coloring and the ability to reduce with pressure are characteristic signs of angioma.
In case of angiomas of complex localizations, a complex of visualization studies is used. Bone hemangiomas are detected by X-ray of the tubular bones, spine, ribs, pelvic bones, and skull. Angiography of the brain, kidney, lung, lymphangiography, etc. is used to diagnose angiomas of the internal organs. Ultrasound examines the depth of spread of the angioma, the structure and anatomic-topographical features of the tumor, measure the blood flow velocity in the peripheral vessels and the hemangioma parenchyma. Pharyngeal angiomas are detected during an otolaryngologist examination.
If lymphangioma is suspected, a diagnostic puncture is performed to obtain a clear yellowish liquid from the tumor. The differential diagnosis of lymphangioma is carried out with a cyst of the neck, cerebrospinal hernia, lipoma, teratoma, lymphadenitis of the neck.